Adherence to antiretroviral therapy during pregnancy and the first year postpartum among HIV-positive women in Ukraine

Bailey, Heather; Thorne, Claire; Malyuta, Ruslan; Townsend, Claire L; Semenenko, Igor; Cortina‐Borja, Mario

doi:10.1186/1471-2458-14-993

Cited by 21 publications

(21 citation statements)

References 38 publications

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“…However, the barriers to retention in adult care experienced by sexually infected youth may differ from those faced by PHIV adolescents (who comprise the majority of those in paediatric care). Data from the adult population in EE highlight particular adherence challenges faced by young women, with over half of those aged <25 years in a Ukraine cohort reporting that they had missed a dose in pregnancy compared with only 23% aged 25–27 years [91]. …”

Section: Resultsmentioning

confidence: 99%

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Bailey

Cruz

Songtaweesin

et al. 2017

Journal of the International AIDS Society

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Introduction: The HIV epidemics in the Caribbean, Central America and South America (CCASA), Eastern Europe (EE) and Asia and Pacific (AP) regions are diverse epidemics affecting different key populations in predominantly middle-income countries. This narrative review describes the populations of HIV-positive youth approaching adolescence and adulthood in CCASA, EE and AP, what is known of their outcomes in paediatric and adult care to date, ongoing research efforts and future research priorities.Methods: We searched PubMed and abstracts from recent conferences and workshops using keywords including HIV, transition and adolescents, to identify published data on transition outcomes in CCASA, EE and AP. We also searched within our regional clinical/research networks for work conducted in this area and presented at local or national meetings. To give insight into future research priorities, we describe published data on characteristics and health status of young people as they approach age of transition, as a key determinant of health in early adulthood, and information available on current transition processes.Results and discussion: The perinatally HIV-infected populations in these three regions face a range of challenges including parental death and loss of family support; HIV-related stigma and socio-economic disparities; exposure to maternal injecting drug use; and late disclosure of HIV status. Behaviourally HIV-infected youth often belong to marginalized sub-groups, with particular challenges accessing services and care. Differences between and within countries in characteristics of HIV-positive youth and models of care need to be considered in comparisons of outcomes in young adulthood. The very little data published to date on transition outcomes across these three regions highlight some emerging issues around adherence, virological failure and loss to follow-up, alongside examples of programmes which have successfully supported adolescents to remain engaged with services and virologically suppressed.Conclusions: Limited data available indicate uneven outcomes in paediatric services and some shared challenges for adolescent transition including retention in care and adherence. The impact of issues specific to low prevalence, concentrated epidemic settings are poorly understood to date. Outcome data are urgently needed to guide management strategies and advocate for service provision in these regions.

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Section: Resultsmentioning

confidence: 99%

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Bailey

Cruz

Songtaweesin

et al. 2017

Journal of the International AIDS Society

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“…There were 180 antenatal survey respondents, giving an estimated participation rate in the main six-month survey period of 39-49 % [ 19 ]. Of the total 228 postnatal survey respondents, 137 took part during July to December 2011 at five HIV/AIDS centres enrolling also into a postnatal cohort within the ECS; using denominator data from these sites, the participation rate for this period was estimated at 35 % (137/396).…”

Section: Resultsmentioning

confidence: 99%

“…Two cross-sectional surveys (hereafter referred to as the ‘antenatal survey’ and ‘postnatal survey’) were conducted among HIV-positive women attending for obstetric and/or HIV care in Ukraine between July to December 2011, with extension to April 2012 for some sites. The primary objective of the surveys was to measure adherence to antiretroviral therapy (ART) in pregnancy and postnatally [ 19 ]. The current study is a secondary analysis of survey data, to investigate prevalence of and factors associated with depressive symptoms in this study population.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of depressive symptoms in pregnant and postnatal HIV-positive women in Ukraine: a cross-sectional survey

Bailey

Malyuta²,

Semenenko³

et al. 2016

Reprod Health

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BackgroundPerinatal depression among HIV-positive women has negative implications for HIV-related and other maternal and infant outcomes. The aim of this study was to investigate the burden and correlates of perinatal depression among HIV-positive women in Ukraine, a lower middle income country with one of the largest HIV-positive populations in Europe.MethodsCross-sectional surveys nested within the Ukraine European Collaborative Study were conducted of HIV-positive women at delivery and between 1 and 12 months postpartum. Depressive symptoms in the previous month were assessed using a self-report screening tool. Other data collected included demographics, antiretroviral therapy (ART)-related self-efficacy, and perceptions of risks/benefits of interventions to prevent mother-to-child transmission (PMTCT). Characteristics of women with and without a positive depression screening test result were compared using Fisher’s exact test and χ2 test for categorical variables.ResultsA quarter (27 % (49/180) antenatally and 25 % (57/228) postnatally) of participants screened positive for depressive symptoms. Antenatal risk factors were living alone (58 % (7/12) vs 25 % (42/167) p = 0.02), being somewhat/terribly bothered by ART side effects (40 % (17/43) vs 23 % (30/129) not /only slightly bothered, p = 0.05) and having lower ART-related self-efficacy (43 % (12/28) vs 23 % (25/110) with higher self-efficacy, p = 0.05). Postnatally, single mothers were more likely to screen positive (44 % (20/45) vs 21 % (18/84) of cohabiting and 19 % (19/99) of married women, p < 0.01) as were those unsure of the effectiveness of neonatal prophylaxis (40 % (20/45) vs 18 % (28/154) sure of effectiveness, p < 0.01), those worried that neonatal prophylaxis could harm the baby (30 % (44/146) vs 14 % (10/73) not worried p < 0.01) and those not confident to ask for help with taking ART (48 % (11/23) vs 27 % (10/37) fairly confident and 15 % (4/26) confident that they could do this). Of women who reported wanting help for their depressive symptoms, 82 % (37/45) postnatally but only 31 % (12/39) antenatally were already accessing peer counselling, treatment adherence programmes, support groups or social services.ConclusionsA quarter of women screened positive for depression. Results highlight the need for proactive strategies to identify depressive symptoms, and an unmet need for provision of mental health support in the perinatal period for HIV-positive women in Ukraine.

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“…Older age was associated with a decreased risk of viral rebound in women who started ART in pregnancy and their controls. This is likely to be a result of better drug adherence in older women [ 17 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy

Huntington¹,

Thorne²,

Newell

et al. 2015

Aids

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Objective:The objective of this study is to assess the risk of viral rebound in postpartum women on suppressive combination antiretroviral therapy (cART).Methods:Using data from the UK Collaborative HIV Cohort (UK CHIC) study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC), women with HIV-RNA 50 copies/ml or less at delivery in 2006–2011, who started life-long cART during pregnancy (n = 321) or conceived on cART (n = 618), were matched by age, duration on cART and time period, with at least one control (non-postpartum). The cumulative probability of viral rebound (HIV-RNA >200 copies/ml) was assessed by Kaplan–Meier analysis; adjusted hazard ratios (aHRs) for the 0–3 and 3–12 months postdelivery (cases)/pseudo-delivery (controls) were calculated in Cox proportional hazards models.Results:In postpartum women who conceived on cART, 5.9% [95% confidence interval (95% CI) 4.0–7.7] experienced viral rebound by 3 months, and 2.2% (1.4–3.0%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during the first 3 months [aHR 2.63 (1.58–4.39)] but not during the 3–12 months postdelivery/pseudo-delivery. In postpartum women who started cART during pregnancy, 27% (22–32%) experienced viral rebound by 3 months, and 3.0% (1.6–4.4%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during both postdelivery/pseudo-delivery periods [<3 months: aHR 6.63 (3.58–12.29); 3–12 months: aHR 4.05 (2.03–8.09)].Conclusion:In women on suppressive cART, the risk of viral rebound is increased following delivery, especially in the first 3 months, which may be related to reduced adherence, indicating the need for additional adherence support for postpartum women.

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Adherence to antiretroviral therapy during pregnancy and the first year postpartum among HIV-positive women in Ukraine

Cited by 21 publications

References 38 publications

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Prevalence of depressive symptoms in pregnant and postnatal HIV-positive women in Ukraine: a cross-sectional survey

The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy

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